Project Summary The parent U19, ?Southwest Hub for American Indian Youth Suicide Prevention?, builds capacity among local tribal governments, investigators, interventionists, and service providers across three Southwestern states to: 1) identify at-risk youth and gather robust local data through surveillance; 2) provide regular monitoring and brief interventions to close gaps in continuity of care; and 3) convene regularly for shared learning, policy development, and dissemination of best practices. The parent U19 includes an innovative SMART trial study design. The purpose of this supplement is to gather data through these mechanisms on opioid use. Our supplement aims are to: 1) expand suicide surveillance in the Southwest Hub to include opioid use as a potential precipitant, facilitator and risk factor for subsequent suicidal behavior; 2) explore community beliefs about correlates of risk, protective factors, and behavior functions of opioid abuse in Native American youth through focus groups with the existing Community Advisory Boards from the 5 Hubs; and 3) use a mixed methods approach to examine opioid use among our SMART trial participants through addition of a quantitative opioid related measure and qualitative interviews with a subset of those who endorse recent or current use. This supplement is important and timely due to the pressing urgency of the opioid epidemic nationally, and the community readiness of our partner tribes to address opioid use locally. This research will further the scientific impact of the parent U19 and supplement, as suicide and opioid use are related risks and not isolated public health epidemics.